Rates of Smoked Tobacco Use Decline While Cannabis Use Increases Among US Young Adults

This study analyzed data on smoked tobacco (i.e., cigarette and cigar) and cannabis use, examining exclusive (use of only one of these substances) and dual use from a US national survey of 18–22 year olds conducted 2002–2016.

• Over the course of the study, past-year exclusive smoked tobacco use decreased significantly from 23% in 2002 to 12% in 2016 among young adults in college, and from 34% to 18% among those not enrolled in college.
• Past-year exclusive cannabis use increased significantly from 6% in 2002 to 15% in 2016 among young adults in college, and from 5% to 11% among those not enrolled in college.
• Compared with those in college, young adults not enrolled in college had a significantly higher prevalence of smoked tobacco and dual tobacco/cannabis use; those enrolled in college had a significantly higher prevalence of exclusive cannabis use.

Comments: After many decades of public health efforts, smoked tobacco use among young adults has decreased in general, although it is declining more slowly among young adults not enrolled in college, underscoring the challenges of reversing substance use epidemics. Rates of cannabis use are on the rise among young adults; this pattern is likely influenced by its legalization in several states, medicalization— which portrays cannabis as benign or even healthful—and an overall decreasing perception among the US public of its risks. These increasing rates are concerning because they may portend a new epidemic.

Sharon Levy, MD

Reference: Odani S, Soura BD, Tynan MA, et al. Tobacco and marijuana use among US college and noncollege young adults, 2002–2016. Pediatrics. 2019;144(6) e20191372.